According to Dr Back, the sudden change in intensity of monitoring experienced with the end of therapy can be jarring for patients, leaving them with conflicting emotions.

“Patients reported feeling surprised by the emotions that they experienced,” said Dr Back. “They often feel set adrift by the cancer care team, as though they are losing this lifeline. Many feel as though they receive a lot less guidance after their cancer treatment ends than when they were dealing with acute side effects.” As a result of this, new anxieties pertaining to their social life, career, or financial situation can surface in patients.

“It’s important to keep these feelings in mind and acknowledge your patients’ emotion,” he observed.

Dr Back also suggested providing take-home information, like a survivorship plan, to help patients stay on track, and he stressed the importance of setting proactive plans.

Dealing with Recurrence Scares

In Dr Back’s opinion, patients’ confidence in their team can actually make the end of therapy more difficult, as they experience less contact with their physicians and more limited access to specialists. Patients have concerns over how nonspecialists interpret new data, he noted, and some have even expressed fear over finishing chemotherapy.

“This is one of the problems that primary care physicians face,” said Dr Back. “The vulnerability [that patients feel] in the absence of anticancer treatments can be enormous.”

Recurrence may invoke the terror of initial diagnosis, a patient’s sense of profound temporariness. The key, said Dr Back, is noticing the “emotional stream of things” because that’s how people process threat.

“Emotions are involuntary,” he explained. “They happen faster than rational thought. Noticing and addressing this emotion is critical to get to the factual information that patients need to absorb.”

Another communication strategy is reminding patients what worked before as a way of mobilizing their own strengths.

“A huge piece of survivorship is about self-management,” he added, “but assuming it’s all under control may worsen stress, as patients feel that they’re being ignored.”

Making Decisions with Uncertainty

Given the dearth of available data, the uncertainty facing survivors can be daunting.

“Sometimes the level of knowledge brought to making decisions about adjuvant therapy may be lacking, with respect to screening and the rest of care,” Dr Back observed.

In the absence of definite knowledge, he advised presenting some best- and worst-case scenarios.

“Patients are very respectful of their oncologist’s experience, which they consider a second type of research,” he said. “Showing that you can provide a decision-making process or support for their concerns is incredibly valuable for patients who may be spinning out of control.”

Experiencing Posttraumatic Stress

Surviving cancer requires developing new coping skills, said Dr Back, as normal psychological defenses may prove insufficient. Seemingly routine events can even trigger flashbacks in survivors, many of whom are suffering from posttraumatic stress.

“It doesn’t matter how much stress you deal with in your professional
life,” he said. “You can still be vulnerable to the discombobulating effects
of cancer.”

Once again, noticing patterns of emotion is critical for providers, as is working to normalize patients’ feelings when appropriate. Although Dr Back generally advocates self-management, a therapist may provide the solution for persistent and troublesome psychological symptoms.

“Vulnerability, loss, and insecurity are common challenges for patients,” said Dr Back. “Successful survivors
affirm the sense of challenge by using true defenses—humor, sublimation, and altruism.”